INTRODUCTION TO CHALLENGING BEHAVIORS

Challenging behaviors are those that involve danger to the child, others around them, or that limit access to the community. Children with autism or Asperger’s syndrome may ‘break the rules’ associated with fair play, sharing and taking their turn, and when and how to show emotions. They may also have trouble with interpreting and responding to nonverbal communication, knowing when to speak and how to get a point across, and which parts of a person’s body may be seen naked or touched.

Challenging behavior includes but is not exclusive to:
• Non-compliance
• Physical aggression
• Verbal aggression
• Self-injury
• Property destruction
• Sexual assault.

Why do challenging behaviors occur?

Every child is born perceiving themselves at the center of their universe. As they grow, they realize that other people exist separately to themselves. In turn, they realize these other people have needs and wants that may conflict with their own, and in the words of the Rolling Stones, “you can’t always get what you wanted”.

In a sense, the process of becoming an adult is learning to respect other people’s needs and balancing them with your own. Children with autism and Asperger’s syndrome have great difficulties in this area, as the disorders involve problems with seeing the world from another person’s perspective (see Theory of Mind). A child with autism is not wilfully engaging in challenging behavior more than any other child would. They simply have much more trouble in developing this awareness of others that modifies and refines our behavior.

Some causes of a challenging behavior could be:

• Wanting something they can't have
• Social attention
• Sensory problems with unpleasant light, sound, textures, touch, smell or temperature

• Illness or mood

• Lack of control

• Feeling swamped by high expectations or complex activities.

the parent as 'behavior detective'

A common principle in behavior management is looking for what the child is communicating through their behavior. The young boy screaming in the supermarket trolley may have wanted that yogurt, may be overcome by all the noise, or finds the hard seat in the trolley uncomfortable. The parent of an autistic child need to be a 'behavior detective' - investigating the cause of a behavior and forming appropriate responses, particularly if it occurs regularly.

behavior response cycle

Determining the cause, or causes, of a challenging behavior in very important as it determines the best way to respond to the behavior. The following example looks at the behavior response cycle in emotional outbursts in Bruce, a young man with autism living in a residential setting with others who are on the autism spectrum as well. Staff had consistently had problems with Bruce going out in public without support, throwing objects and assaulting fellow residents and staff.

The behavioral consultant’s first step was to work with staff in identifying antecedents to the behavior — the ‘triggers’ in the environment that begin Bruce’s move to an angry outburst. This uses the ABC model that underlies Applied Behavior Analysis.

The consultant asked staff to list what happened in the Trigger, Escalation, Crisis and Recovery phases. This helped staff to understand why Bruce acted as he did and paved the way to make a suitable response to each challenging behavior Staff were then able to work together on developing these responses which would be consistently applied by all from that point on. Staff worked on making verbal responses to possible situations and engaged in role plays to practice their responses.

A major benefit of this model is that it can help staff, carers and family members to realize that there is normally a trigger to behaviors which can often be avoided, or at least recognized. This understanding also frees people from reacting in a punitive, emotional or negative way, and choosing a reasoned response. A reasoned, consistent response from everyone involved can make a major change in many cases.

The chart below shows an analysis of the steps leading to each behavior.

picking and choosing your battles

There will often be a range of challenging behaviors displayed by a child with autism or Asperger's syndrome. It is usually best to concentrate on one or two of the major behaviors first before tackling other ones. This six point list can help when you need to decide whether you should intervene or when you need to prioritize between providing support to a number of individuals who would benefit:

• When the frequency, duration or intensity of the behavior is no longer within the boundaries of what is accepted in the community
• When the behavior occurs at times, in places or in situations when it is no longer within the social norms of the community
• When the behavior infringes upon the health, well being, or property of the individual or others
• When the behavior seriously infringes on the individual’s development or interactions
• When the behavior interferes with learning new skills that could enhance the individual’s quality of life
• When the individual believes the behavior needs to be changed.
(McDonald, 1994)

Considerations in developing behavior strategies

Autism and Asperger’s syndrome have distinct features that complicate the usual behavioral management strategies we have read about or learned from our parents. Making a child feel guilty about the consequences of their actions for others may not work, as the child will have trouble seeing another person’s perspective on the issue. Likewise, positive reinforcement by praising a child may be less effective as the child may have trouble seeing the parent’s perspective, so the parent’s approval is seen as less important.

“You can have ice cream back home if you stop doing that”. “If you behave like that we won’t go to the beach tomorrow”. An autistic child lives very much in the present so future rewards or negative consequences tend to have very little effect on behavior.

Autism and Asperger’s are developmental disorders these delays in development can compound over time if not addressed. Responding appropriately to challenging behaviors is a vital part of minimizing these delays. Challenging behaviors should not be just accepted as part of the disorder. Consistently applying behavioral strategies will benefit the child greatly in the long run. Click here to read more about setting up a Behavior Management Program.

Preventative strategies

Parents can do proactive things to minimize the chances of challenging behaviors arising in the future. Maintaining routines is an obvious strategy to reduce stress for an autistic child. When a change is likely, let the child know well in advance and remind them repeatedly. Set very clear boundaries and be consistent in applying these and explaining them.

Minimize the known 'triggers' whether it be loud environments or disturbing sensations. Experiment with different calming and relaxation techniques and integrate the effective ones into the child's day. Use plenty of visual cues, such as a timetable on the wall to help the child know daily and weekly routines.

Encourage learning of new tasks and skills as much as possible. Sometimes challenging behaviors arise because a child is frustrated at not having the necessary skills to cope with a task or situation.

Medications and behavioral issues

In some cases, behavioral management programs may be supported by medications to reduce challenging behaviors. Parents and doctors are wise to be cautious in using medications with children, but the benefits may outweigh the costs in more extreme cases. The medications used are those that have been developed to treat similar symptoms in other disorders. Antipsychotic medications have been used for severe behavioral problems, as they reduce activity of dopamine in the brain. Typical antipsychotics like chlorpromazine, haloperidol, thioridazine and fluphenazine have been tested and found useful in managing extreme behavioral problems. However, further research is needed in their use with children and adolescents.

Where's the love?

Challenging behaviors can dominate a family and it is natural for parents and siblings to feel anger, frustration and resentment. However, it is very important to separate the behavior from the child, so that these feelings are associated with the behaviors, not the child. It can be quite easy to slip into thinking a child with autism or Asperger’s is actively choosing to create havoc, or deliberately ignoring the needs of others. Parents need to remind themselves continuously of how the world will appear through their child's eyes, and appreciate the long uphill battle they face in taking other people’s needs into account as they develop.

Click here to read a fact sheet on maintaining a positive attitude when dealing with challenging behaviors.

Click here for the full range of Asperger's and Autism fact sheets at www.autism-help.org
Article adapted with permission and remains under the copyright of www.biaq.com.au